Happy Thanksgiving!

A member was once asked about her most memorable days on the job. She told a story about a cancer patient who was dying. The patient wanted our nurse to go in and hang out with her a little bit each day as she went through the transitioning process. No matter how many others were on the floor and no matter how few staff were on duty, this nurse always had a little more time, somehow, to sit with her patient.

Fortunately for me I know a lot of these stories from being around you all. Other favorites of mine include the one from a nurse in the Midwest who explained to me that sometimes holding a hand is all that is needed to relieve a patient’s night tremors, and then there are the superhero ones: saving a life on a cross-country flight, bringing aid to someone in a car accident (after 12 hours of work) on the side of a freezing cold highway, and so on.

While we cook, clean, eat, spend time with family, friends, neighbors we will also likely get around to talking about what we are the most thankful for. We all have our lists, even if we don’t share them aloud. For me, I have so much gratitude knowing so many of you are not only healing and saving lives because it is your job, but you are also comforting and soothing, showing infinite compassion and empathy -- and you do it all from a foundation most folks would never really get.

This week I was looking for a picture on Google to use on a website I help maintain. Along with hundreds of other images that came up from my search was one that said, “Nurse: The Hardest Job You’ll Ever Love.” And I smiled at the reworking of the old Peace Corp saying.

You all do such amazing work day in and day out. Frequently it is thankless, unfair, miserable, exhausting but you do it with dignity and pride. With the backaches and balancing your families and homes, you union activism, and all else in your lives, you are doing this incredible work. So, I wanted to make sure that you were thanked today. I wanted to make sure that you know that you make a difference. While we continue to work toward protecting our rights on the job, passing new protective legislation and all else that comes from being in a union like ours, my hope is that at some point you get to put your feet up and feel the gratitude that I and so many millions of others have for you and your calling to the nursing profession.

Have a fantastic Thanksgiving!

-Richard

In this issue of the RoundUp we have three articles for you to dive into. One is about shift changes, another on bullying in the workplace, and finally we have a piece from our National Nurse Alliance Coordinator, Jen Stange, on the Lame Duck Congress. Please feel free to write in with your thoughts about these pieces and anything else (Richard.Negri@seiu.org). And by all means pass this on to any SEIU Nurse who should be getting the RoundUp on a regular basis.

Shift Changes: The impact on you, the danger to patients

Last week as many of us were slowly coming down from the adrenalin high of reelecting President Obama, a flood of articles in the trade journals about shift changes, and a recent study on the subject, were filling my in-box.

The crux of the study reveals that the way doctors and nurses exchange patient information during shift changes could help improve patient care and save lives. Though this is hardly breaking news, the fact that the study is getting this level of attention in our journals might help propel the issue to the forefront of people’s minds and get the ball rolling on implementing potential remedies.

Earlier this year, at a conference in NYC, a nurse shared with me that shift changes are among her biggest problems on the job. She explained that while nurses will mostly focus on patients’ acuity, she found that some doctors would go down a list by room number or bed number or “who the heck knows….”

The researchers of this study analyzed 23 shift change handoffs of 262 patients admitted in a Canadian facility. It finds that some doctors are spending too much time talking about the first cases on their list. They end up rushing through patients toward the bottom of the list, regardless of the fact that some of the folks at the bottom of the list might have injuries or illnesses considered more severe than others at the top of the list.

With more than half a billion shift change handoffs in U.S. hospitals each year, you’d “expect that people would shift to talking about the sickest patients first, or the most unfamiliar of complex cases,” Michael Cohen, lead author of the study and professor of complex systems, public policy and information at the University of Michigan, said in a statement.

Cohen, et al., say that there isn’t a one-size-fits-all remedy except to say that people doing the handoff should begin with making judgment calls as to which patients need the most time.

What kind of a training program do we need, and what would that look like if every facility and every shift are entirely different from each other?

Cohen says that handoff conversations aren’t anything new, but training on how to conduct “proper handoffs” has only just begun to be offered to healthcare providers.

I want to know how the handoffs are where you work. What can be done better? Is there available training on handoffs?

With the amount of handoffs we deal with, “just an increase of one-tenth of 1 percent in their effectiveness could translate into a large number of prevented injuries and lives saved,” Cohen says.

What’s your take? Do you agree with his findings? When you write in, please let me know if I can publish your name, title and local union in a future RoundUp and our websites.

Bullying?

In the last few years of working with our nurses via the Nurse Alliance, we have covered a lot of intense issues. They run the gamut from workplace violence and safe patient handling to safe staffing ratios. In this issue, the problems surrounding changing shift are examined. Yet, there is one area that hasn't been fully acknowledged: workplace bullying.

There are so many intricate nuances to the issue of bullying on the job. That should not push us away from the obvious: respect and civility need to be the accepted norms in every one of our workplaces, regardless of our seniority, our titles, our educational backgrounds, or any other aspect of nursing. If we don't respect each other, if we don't demand respect from our employers, the issue of workplace bullying will continue on long after we all retire. Therefore, everyone reading this now should pledge to be an agent for change -- a real deal agent for change where civility and respect is the rule and not the exception.

In every work situation there will be a fair amount of disagreement among workers and management, and working through disagreements in a fair, honest, and compassionate manner is healthy. What isn't healthy is when a disagreement turns to verbal abuse, sabotaging each other's performance, or worse, physically getting into it.

According to a Public Employees Federation fact sheet on co-worker conflict there are common bullying behaviors we ought to know about to help us identify what we're dealing with:

• False accusations of mistakes and errors
• Hostile glares and other intimidating non-verbal behaviors
• Yelling, shouting and screaming
• Exclusion and the "silent treatment"
• Withholding resources and information necessary to the job
• Behind the back sabotage and defamation
• Use of put-downs, insults, and excessively harsh criticism

When there is any abusive behavior at work that is repeated over a period of time, where the victim experiences difficulties in defending themselves, that is workplace bullying, and it should not be tolerated.

Studies prove some of the obvious health effects of bullying:

• Stress disorders of all types
• Clinical depression
• High blood pressure
• Cardiovascular disease
• Impaired immune systems
• PTSD

Last month, SEIU President Mary Kay Henry gave a talk at the National Press Club in support of a "Healthy Workplace Bill." In her speech she mentioned that many of us are told that bullying (and all workplace violence) is "part of our job." That, she said is, "not acceptable." (Click here to watch the Mary Kay speech)

How can you become an agent of change? You need to work with your colleagues and local unions on creating or strengthening a workplace violence prevention program. The work you do within the prevention program may be very different from facility to facility, but it is safe to say that establishing clear norms of behavior and procedures for dealing with any breach of those norms should be included in policy agreed upon by both labor and management.

You can also be an agent of change by sharing your experiences with bullying at your jobs with all of us. Mary Kay said that we must break the silence around this issue for a number of reasons -- including the fact that this is part of a larger social and economic justice fight.

None of us go to work to get bullied, beat up physically or emotionally, ignored or sabotaged. None of us go to work to get the silent treatment or to leave the job exhausted from work and intense stress that bullying brings on. Clearly none of us go to work at the start of our shift with the mindset that we deserve to be treated disrespectfully.

Can you pledge to be an agent of change with me? Even if you don't write an article and share your experiences, please send me a note saying you are in this with me.

Protecting the foundations of our healthcare system in the lame duck Congress

By Jen Stange, National Nurse Alliance Coordinator

We went all in to re-elect President Obama and a strong set of healthcare champions, and November 6 was a great victory that we can be proud of.

However, we know that our work never stops with election day— we are already fighting back threats to our healthcare system and to remind Congress that we voted for Jobs not Cuts and to protect Medicaid and Medicare in the Lame Duck Congress.

Throughout the fights over the Federal Budget and through the election, many Republicans members have made it clear that they want to fundamentally undermine the foundations of our healthcare system. The Nurse Alliance of SEIU Healthcare must be ready to push back on any proposals that dramatically cut Medicaid and Medicare or undermine the Affordable Care Act. We know our patients count on the life-saving care that Medicaid, Medicare and the Affordable Care Act help us deliver.

We are the frontlines of the American healthcare system, and if proposals for multibillion dollar healthcare cuts surface, we will need the SEIU nurse voice pushing back in national and local media.

SEIU launched an online petition calling on Congress to support our mandate. Sign up here

We voted for strengthening the middle class and putting people back to work, not for job-killing budget cuts. We said no to cutting healthcare and education to pay for tax breaks for the rich. We want jobs, not cuts. We know that any deal reached in the Lame Duck Congress must:

• Create jobs and grow the economy
• Protect Medicare, Medicaid, and Social Security
• Let the Bush tax cuts for the top 2% expire and require corporations to pay their fair share
• End the scheduled across-the-board cuts with a responsible solution that includes new revenue
• We know it’s time to grow - not slow - the economy

We should invest in good jobs, education and infrastructure and make the rich pay their fair share of taxes. We agree with President Obama that we need to grow the economy from the middle out, not the top down. The Nurse Alliance of SEIU Healthcare will continue to stand up for what’s important to our patients and to middle class families.

May you have a wonderful holiday.

Richard Negri SEIU Nurse Alliance